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Questions to ask when evaluating diabetes management options
Workplace diabetes management is ripe for innovation and there are new solutions employers should consider, says a May 2015 report from the nonprofit Northeast Business Group on Health (NEBGH).
Transforming Diabetes Management: New Directions for Employers, describes how patient-centered medical homes, onsite clinics, near-site and convenience clinics, diabetes-oriented centers of excellence and pharmacist-led programs, often enhanced with new digital health tools, have emerged and are ready to provide improved care to employees, spouses and dependents with diabetes.
Patient-centered medical homes are arrangements among health care providers that are designed to put primary care doctors in charge of coordinating and managing patient care across conditions, providers and settings.
Centers of excellence are hospitals or clinics rated as offering high-quality, cost-effective care. Employers and insurers may offer workers lower-cost care if they seek treatment at a designated center of excellence.
“Tackling diabetes is a top priority for our employer members, and they’re frustrated by the failure of traditional diabetes management programs,” Laurel Pickering, president and CEO of NEBGH, said in a news release. “New models of care, combined with employer-sponsored activities such as providing rewards and incentives, creating a culture of health, and experimenting with digital tools that support employee engagement, create a new landscape of diabetes management solutions that could really help employers move the needle when it comes to the diabetes epidemic.”
“Employers have so much to gain with even modest success in diabetes management—and so much to lose if nothing is done,” added Jeremy Nobel, MD, executive director of the NEBGH Solutions Center.
NEBGH’s latest report follows
its 2014 findings that highlighted the lack of employee engagement in diabetes management programs and cited the need for more innovation. Nationally, diabetes threatens the health of over 100 million employees and accounts for $175 billion in direct medical costs and $70 billion in indirect costs stemming from lost productivity, disability, mortality and early retirement, according to the report.
Innovative approaches to care delivery should be driven by payment models that encourage providers to deliver high-value care and are structured to promote value of services, not volume, the report advises. It’s also important for employers to evaluate new approaches based on the needs of their specific employee populations and the organizational landscape—the company’s characteristics, culture, strengths and weaknesses.
Questions to Ask
The report includes a series of questions employers can ask when evaluating diabetes management options, including whether they should:
Consider onsite or near-site care programs?
• Is there a large population within a distinct geographic location?
• Are there local care providers that can be contracted with to offer dedicated support for your organization?
Reallocate resources dedicated to existing traditional population health management?
• Can you engage your existing vendors to identify creative ways to deploy those resources to assist in a care setting?
• Can funding be allocated to primary care, a center of excellence (COE) or even digital programs to reach a broader audience?
Expand use of digital tools for care delivery and engagement?
• Which vendors have proven outcomes and are they willing to work at risk?
• Can you design a program that provides greater options in curated digital tools, eliminating the need for one single program to solve all needs?
• How will employees be encouraged to use the program?
• How will digital tools integrate with care providers?
Contract with a center of excellence?
• Is there a COE in your geographic region?
• How is that COE defined and evaluated?
• Can the population be segmented to consider a COE for high-need, high-risk individuals only, and can you steer the rest of your population to more accessible resources?
Implement new value-based payment models?
• How educated are you about these models?
• How can your health plan help you?
• Can you measure the value?
Communicate new programs?
• How is the culture of health perceived in your organization?
• What communication strategies have worked and not worked for your population?
• Can an employee’s family also be engaged to change the perception of diabetes, engaging them in care opportunities?
• Can incentive and reward programs be tailored to meet the needs and outcomes of this population?
• Do you have tools to measure these programs?
Diabetes Spending on the Rise
Diabetic adults covered in employer-sponsored insurance have annual health care costs that, on average, are nearly $15,000, which is $10,000 more than their nondiabetic peers, according to a May 2015 study by the nonprofit Health Care Cost Institute (HCCI),
Per Capita Health Care Spending on Diabetes: 2009-2013.
In 2013, the last year for which cost data were available, pre-65-year-old adult diabetics on employer-sponsored plans saw their health care spending increase to about $15,000 per capita, according to HCCI. The analysis used claims data from Aetna, Humana, Kaiser Permanente and UnitedHealthcare.
Total Per-Capita Expenditures for Insures, With and Without Diabetes
Individuals with diabetes also pay a greater amount out-of-pocket than their nondiabetic peers, on the Individuals with diabetes also pay a greater amount out-of-pocket than their nondiabetic peers, on the order of 2.5 times more.
Stephen Miller, CEBS, is an online editor/manager for SHRM. Follow him on Twitter
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